Berruto Massimo, Uboldi Francesco Mattia, Ferrua Paolo, Vergottini Giovanni, Manunta Andrea
Department of Knee Surgery, Gaetano Pini Hospital, Milan, Italy.
Department of Orthopaedics, University of Sassari, Sassari, Italy.
Joints. 2018 Mar 7;6(1):33-36. doi: 10.1055/s-0038-1636949. eCollection 2018 Mar.
To evaluate the long-term results of classical "à la carte" surgical treatment of objective patellar instability as proposed by Dejour in 1987. A multicentric retrospective study was conducted evaluating patients that underwent surgical procedure with a 10-year minimum follow-up (mean 12.7; range, 10-15). Surgical procedures were medial transfer of the tibial tubercle transfer according to Elmslie and Trillat et al in 38 cases, plasty of the vastus medialis obliquus according to Insall in 15 cases, open lateral retinacular release in 13 cases, capsuloplasty in 3 cases, and trochleoplasty in 1 case. Different combinations of surgical procedures were adopted according to the pathological features. Subjective outcome was assessed with the visual analog scale (VAS), Kujala score, subjective International Knee Documentation Committee (IKDC) score, Tegner score, and Crosby and Insall scale. Radiographic exams were used to assess the patellar tilt by the Laurin's angle and patellofemoral osteoarthritis (OA) according to the Iwano radiological OA scale. Forty patients were evaluated. Subjectively, 60% of patients achieved a result judged good, 34% sufficient, and 6% poor. There were only two cases of recurrence of instability. Mean score results were Kujala score 73.4 ± 9.9 (range, 55-95), VAS 4.5 ± 1.2 (range, 1-6), IKDC 64.8 ± 7.9 (range, 51-88), and Tegner score 4. Only nine patients returned to sports activities). Ten patients developed a grade I patellofemoral OA, 8 patients a grade II, and 22 patients a grade III. Average patellar tilt was 10° ± 3.9°. This retrospective study showed that the traditional surgical procedure was successful for the treatment of patellar instability, but it did not prevent symptomatic patellofemoral OA. Level IV, retrospective case series.
评估1987年德茹尔提出的针对客观髌骨不稳定的经典“点菜式”手术治疗的长期效果。进行了一项多中心回顾性研究，评估接受手术治疗且随访至少10年（平均12.7年；范围为10 - 15年）的患者。手术方式包括38例按照埃尔姆斯利和特里拉特等人的方法进行胫骨结节内侧移位术，15例按照英萨尔的方法进行股内侧斜肌成形术，13例进行外侧支持带开放松解术，3例进行关节囊成形术，1例进行滑车成形术。根据病理特征采用了不同的手术组合。主观结果采用视觉模拟量表（VAS）、库亚拉评分、主观国际膝关节文献委员会（IKDC）评分、特格纳评分以及克罗斯比和英萨尔量表进行评估。通过劳林角评估髌骨倾斜度，并根据岩野放射学骨关节炎量表评估髌股关节炎（OA）。对40例患者进行了评估。主观上，60%的患者结果判定为良好，34%为尚可，6%为差。仅2例出现不稳定复发。平均评分结果为：库亚拉评分73.4±9.9（范围为55 - 95），VAS为4.5±1.2（范围为1 - 6），IKDC为64.8±7.9（范围为51 - 88），特格纳评分为4。只有9例患者恢复了体育活动。10例患者出现I级髌股关节炎，8例为II级，22例为III级。平均髌骨倾斜度为10°±3.9°。这项回顾性研究表明，传统手术方法在治疗髌骨不稳定方面是成功的，但不能预防有症状的髌股关节炎。IV级，回顾性病例系列。
